Health Care Case Study
Case #12003: Senior Markets — Marketing, Product Launch and Filings
The Senior Services division of a national Health Benefits Organization was anticipating growth in its Medicare Advantage and Supplemental membership by over 12% and was entering the Medicare Part D market with open enrollment. Questas was engaged to provide managerial support to the Compliance Department and assist with the initial set up and infrastructure development for a Medicare Part D Compliance process.
The Compliance Department was chartered to provide regulatory oversight for the Medicare Part D, Medicare Advantage and Medicare Supplement products as well as supportive activities to the Sales and Marketing departments. The Compliance department did not currently have the resources, infrastructure or processes in place to achieve compliance or report on the status of attainment.
Engagement Highlights
- Industry:
- Health Insurance
- Client:
- A National For-Profit Health Benefits Organization
- Assignment:
- Create marketing material templates - such as for Evidence of Coverage booklets for the upcoming enrollment year
- Work with internal staff to draft member correspondence and answer internal questions regarding the materials and information
- Provide content and review of marketing materials, and participate in reviews of member correspondence, enrollment and post enrollment materials and brochures to ensure compliance with federal requirements
- Coordinate, develop and assemble application filings for new and expanded products
- Ensure that filings are completed within established timeframes / deadlines
- Approach:
- Coordinated with The Centers for Medicare and Medicaid Services (CMS) and the various Health Plan departments to create applications and materials
- Worked with CMS to ensure that filings of applications and materials received approvals
- Provided update, editing and additional information to CMS where needed
- Coordinated with Operations, Product Development, Compliance and other internal areas
- Duration:
- 8 months (over a 16-calendar-month period - 4 months in year one and then 4 months for year two)
Results
- Achieved new filings in fifty (50) states
- Launched initial Medicare MSA
- Developed and mailed marketing brochures and materials in fifty states
- Established an ongoing process for new Medicare mailings and templates for future use
- On-boarded in excess of 200,000 new members and currently expanding the MA membership